Delayed interval delivery in multifetal pregnancies in the second trimester: maternal and neonatal outcomes

Abstract

Objective: A short latency period (mean = 1.1 days) and poor neonatal outcomes make the management of multifetal pregnancies who present in the second trimester with rupture of the membranes a difficult problem. Recent reports of attempting delayed interval delivery with antibiotics or tocolysis, with or without cerclage, have been encouraging. We describe our experience over the last 7 years.Study design: We reviewed our database for all patients who had a multifetal pregnancy in the second trimester with rupture of the membranes and were offered an attempt at delayed interval delivery. All women were counseled about the potential risks and benefits of this management and offered cervical cerclage. We compared the neonatal outcomes between the delivered fetus and the remaining fetuses. We also reviewed the charts for maternal outcomes. Fisher’s exact and Mann Whitney U tests were used where appropriate.Results: There were 10 women who attempted delayed interval delivery in the second trimester. There were six twin and four triplet pregnancies. All women received aggressive tocolysis and antibiotic therapy immediately after delivery of the presenting fetus. Four women opted for cerclage placement. The mean gestational age at delivery of the presenting fetus was 23.3 weeks versus 25.5 weeks for the remaining fetuses (P = 0.14), with a birth weight of 630 g for the presenting fetus versus 885 g in the remaining fetuses (P = 0.07). The mean prolongation of pregnancy was 16 days (range, 1–46 days; mode, 9.5 days). There was a 30% survival in the delivered fetus versus 60% in the remaining fetuses (P = 0.37). There was no difference in delay in delivery between those patients who received a cerclage and those who did not (13.8 versus 17.5 days; P = 0.83). There was significant maternal morbidity in five cases. Four cases had endomyometritis and one case had Gram-negative sepsis, adult respiratory distress syndrome, and renal failure.Conclusions: Offering women delayed interval delivery who have a multifetal pregnancy in the second trimester with rupture of the membranes continues to be a reasonable option. Nonetheless, given our experience, patients must be counseled regarding the potential for serious infectious morbidity.